COVID-19 - What Providers Need to Know

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An exception to the following: Telehealth coverage for self-funded plans is based on individual plan coverage.

Coverage

Quartz will cover COVID-19 related services for fully insured members including:

  • Testing: Quartz will cover testing – whether results are positive or negative.
  • Quarantine: Quartz will cover quarantine if in a health care facility that is ordered and supervised by a certified healthcare provider. This applies whether patients test positive or negative.

Alternative Care Options

To preserve capacity for COVID-19 patients, Quartz is waiving member cost-sharing for all telemedicine services through May 31, 2020.

To appropriately waive member cost-sharing for your patients, all provider telehealth claims must have at least one of the telehealth modifiers listed below and listed within our Telehealth Visit Guidelines.

Telehealth Modifiers:

All telemedicine claims must have at least one of these indicators:

Modifiers 

95 - Telemedicine Service

CR - Catastrophe/Disaster Related

CS - Subject to a cost-sharing waiver for testing-related services for COVID-19

GT - Via Interactive Audio and Video Telecommunication System

GQ - Via Asynchronous Telecommunication System

GO - Telehealth Services for Diagnosis Evaluation or Treatment of Symptoms of an Acute Stroke

Traditional True Telehealth Services

Historically in-person services now provided via telehealth

POS 02

POS should equal what it would have been for in-person with modifier 95 to indicate provided by telehealth

Condition Code (UB)
DR - Disaster Related

Commercial and Medicare Claims: 

Quartz will provide coverage for all CPT-identified telemedicine codes and codes published by CMS for fee-for-service Medicare. (Note that ASO customers will make their own member cost-sharing decisions.)

BadgerCare Plus Claims:

Please follow Wisconsin Forward Health coding guidelines.

Resource: CMS and Wisconsin Forward Health coding guidelines.

Visit the ForwardHealth telehealth billing flow chart for BadgerCare Plus members. 

Waiving of Cost-Sharing

  • As noted above, Quartz is waiving member cost-sharing for all telemedicine services through May 31, 2020. As we approach May 31, 2020, we will reassess and determine whether we need to extend the waiving of member cost-sharing in relation to the COVID-19 public health emergency.
  • Costs associated with COVID-19 services: Quartz is waiving out-of-pocket expenses associated with COVID-19 testing and services associated with getting the test.
  • Out-of-network: Prior Authorization is not needed for COVID-19 testing and services associated with getting the test, or for Emergent and Urgent Care access.
  • Relaxing board eligibility requirements: Under a delegated credentialing agreement where the WI Medical Examining Board has granted an unrestricted license, practitioner’s board eligibility status won’t be reviewed by Quartz for practitioners working in hospitals.

Administrative

  • Prior authorization requirements: Outpatient services related to COVID-19 treatment do not need authorization. Inpatient services will be covered by the inpatient authorization following the normal process.
  • Postponed non-COVID elective services due to COVID-19 needs: All existing prior authorizations generally are approved for 90 days already. Starting March 23, 2020, all new prior authorizations that are approved will be extended to 12/31/20. If you have a prior authorization that was approved prior to March 23 and an extension is needed, please reach out to Quartz Medical Management.
  • COVID-19 prior authorizations/referral and other requirements: Quartz will relax administrative requirements for other services during the COVID-19 patient surge. This includes extending timeframes for notice requirements for emergent admissions for both COVID-19 and other care services. Quartz would like to be notified within a week or so for admissions.
  • Provider enrollment timely filing, appeal deadlines, and other administrative requirements: Under this public health emergency (PHE), Quartz will waive timely filing requirements for dates of service during the PHE for all claims filing so that claims and cost of care are not denied based on failing to meet normal contractual requirements.